Dental Network Relations Consultant RFP and Mandates, Onsite Mendota Heights, MN (PS6455) at Anthem, Inc.

Posted in Management 8 days ago.

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Type: Full-Time
Location: Mendota Heights, Minnesota

Job Description:

Anthem, Inc. is the nation's leading health benefits company serving the needs of approximately 40 million medical members nationwide.

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

 

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

This position is located onsite at the Mendota Heights, MN, Anthem office.

The Dental Network Relations Consultant (RFP and Mandates) develops and maintains positive relationships with providers and develops strategies for recruitment and contracting.

Primary duties may include, but are not limited to:



  • Supports and manages RFP process


    • Analyzes questions, gathering and developing responses, managing meetings

    • Maintain RFP library

    • Flexibility to comply with strict turnaround time to gather and distribute information which may include outside of business hours

    • Manage product specific recruitment and tracking

    • Improvement of policies and procedures regarding recruitment activity and tracking

    • Interpret data, including network distribution reports




  • Engage in regulatory mandates which impact networks

    • Attend regulatory and mandate calls

    • Ability to contribute and understand network requirements

    • Tracking and reporting of mandated action items

    • Strategically formulate a network recruitment guarantee and plan of action  



  • Strategically  formulate a network recruitment guarantee and plan of action

  • Develops and maintains positive relationships with the provider community action   by periodic on-site visits, communicating administrative or programmatic changes and facilitating the resolution of provider issues.

  • Recruits providers to build a cost effective, high quality provider network.

  • Conducts negotiations and leads contracting efforts with providers to build and maintain a cost effective, accessible provider network.

  • Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.

  • Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.

  • Conducts seminars to support the understanding of managed care and Blue Cross and Blue Shield policies and procedures.

  • Identifies network access and deficiencies and develops recruitment and contracting strategies.

  • Coordinates and conducts provider training.

 

Requires a BA/BS degree; 3 years of related experience (provider relations, network management, customer service, sales-negotiation); prior negotiation experience; or any combination of education and experience, which would provide an equivalent background.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2017 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran.